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Selective nonoperative management of low-grade blunt pancreatic injury: are we there yet?
Juan C Duchesne1, Robert Schmieg, Saleem Islam
1Section of Trauma and Critical Care Surgery and Preventive Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA. jduchesn@tulane.edu
Background:
Nonoperative management (NOM) of low-grade blunt pancreatic injuries (LGBPI) diagnosed by computed tomographic (CT) abnormalities of the pancreas in the adult hemodynamically stable (HDS) patient has not been previously defined. We report our experience of patients with LGBPI at a single Level I Trauma Center.
Methods:
Adult HDS patients during a 5-year period with blunt pancreatic injuries with an abbreviated injury score of
Results:
A total of 120 patients were identified as having blunt pancreatic injury of which 35, with pancreatic abbreviated injury score of
Conclusion:
NOM of LGBPI diagnosed by CT was successful in the majority of HDS patients, with low morbidity and mortality. We propose a management algorithm for NOM of LGBPI in which the role for early ductal injury detection with endoscopic retrograde cholangio-pancreatogram or magnetic retrograde cholangio-pancreatogram should be incorporated to better analyze the most appropriate treatment.
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